There is growing healthy skepticism about the past promises of mobile technologies. Issues concerning safety after the release of the FDA guidance of mobile medical apps, privacy and security, and efficacy. Followers of the sector are poised for the rubber finally meeting the road in health care. While most mobile health tools used today are reference apps for health care providers and patients, there are ways in which other types of mobile technologies can be immediately useful.
1. Mobile real-time HCAHPS surveys. Recently, the government instituted a system of tying hospital (and provider) reimbursement for services to patient satisfaction scores delivered via Hospital Consumer Assessment of Healthcare Providers and Systems. While there is significant debate over the correlation of patient satisfaction to quality of care, this system is here to stay at least for a while.
One fundamental flaw in the system (which in my opinion makes it a setup for failure), is the marked delay of delivery of the results to institutions. This delay is on the order of 10 months. In addition, surveys may be delivered to patients up to six weeks following discharge. Will someone remember what their ER stay was like before a 3-month hospitalization six weeks after going home?
There are apps available now which allow patients to perform the survey real-time. It would result in more reliable data that providers can act on more quickly which will hopefully improve satisfaction more quickly. CMS does not presently allow this type of technology. One objection is that patients might fear retribution during the hospitalization for negative comments. I submit that this is not a widespread concern and that people would hope that the criticisms would result in positive corrections, and that providers’ ethics would triumph over pride.
2. Point of service mobile patient education tools. There are many patient education tools out there now. Some are provided as a service by pharma and medical device companies (which are naturally challenged as a conflict of interest). Others are provided by some excellent third-party commercial entities. However, the uptake of these apps is low. Providers are in general not delivering digital content to patients. The mandate for utilization of patient portals is only for 10% of hospital Medicare patients and 5% of outpatients. In addition, the requirement for exchange of information is extremely vague. The investment in patient education tools will likely result in improved risk management (decreasing law suits), improve patient adherence to medications and instructions, and allow for caregivers to have access to the information.
3. Video consultations. Venture capitalists are investing in technologies which facilitate medical encounters via smart phones. The market for such interactions has arisen as a natural evolution of the use of mobile technologies in the retail and finance sectors as well as Congressional interest in expanding telehealth services. Lack of adequate access to care (as illustrated in a Merritt Hawkins survey on physician appointment wait times), impact of in-person visits on caregivers, logistical problems for rural patients, and lack of available inexpensive care after hours are all factors which make this technology attractive.
4. Remote patient monitoring (RPM) with lay interpretations for patients and caregivers. There is no doubt that remote patient monitoring will play a large role in the health care continuum. Its importance will grow significantly because of Medicare penalties now imposed to hospitals because of readmissions (with expanding diagnoses and time intervals from discharge in the near future). Problems with many (though not all) RPM tools today include the lack of interoperability with electronic health records, the lack of analytics utilized to make the data actionable and tied to good clinical decision support tools, and the lack of apps which make it a truly mobile technology. Mobile apps incorporating RPM data need to get to patients and their caregivers as well, in digestible lay terms. Data transformed into simple suggestions for either lifestyle changes, instructions to contact a provider, or medication changes will transform RPM from a passive to active tool.
5. Utilization in clinical trials. I foresee the use of apps for recruiting, entering real-time data re: symptoms, adverse events (AE), medication verification and adherence log, and secure messaging with study coordinator. This can potentially result in higher participant retention rates, improved safety (real-time AE reporting), and increased study center communications.
Though there are many more uses for mobile health technologies which can be utilized right now, I believe that the above can exert substantial impact with respect to creating awareness, adoption, and marketing opportunities. What we need are physician and health care administrator champions (who admittedly have much on their plate now), increased awareness of these technologies by the public (caregivers and patients), and expedited regulatory accommodations. It is time for mobile apps to enter health care and emerge from the PR shadows of consumer apps.
David Lee Scher is a cardiac electrophysiologist and a consultant, DLS Healthcare Consulting, LLC. He blogs at his self-titled site, David Lee Scher, MD.
